Par Provider
The field and number indicating a participating provider in CSS.
What is Provider Class 5 (or 1)?
Patient not enrolled at time of service.
What is DF 0009?
Promptly Acknowledge caller, provide seamless customer experience , promptly begin interaction: not eating, drinking or chewing gum.
What is Call Readiness?
Ensures we met all the customer's needs & prevents escalated calls & callbacks.
What is " Is there anything else?"
Both ICS & PCS Tabs on CSS displays 5, 3, or 1
What is Provider Class
Prior to issuing any type of reimbursement to the provider this must be accessed.
What is patient liability?
The explanation of why a claim was denied.
What is a DF Message Code?
Scoring falls into one of these 3 "R" Categories
What is Reinforce, Refine & Redirect
Action appropriate when the caller shows an emotion or concern.
What is Acknowledge the caller?
Payment Reduction Reason Code used describing "Patient not held harmless"
What is "NH"
A participating provider can be given this type of claim (data) information.
What is line level (data) information?
Claim file closed until predetermination obtained by provider is this type of liability.
What is Patient Liability for DF 1296?
If not met, 30 points are lost.
What is Verification?
First Impression of the Company received by the caller.
What is the "Greeting"?
Missing data from the Claims Tab on CSS for a Non-Par Provider?
What is the check number
This field indicates in network provider in the MV service window?
What is "NI" field?
Paired with a patient liability code, this "internal" code does not need to be related to a non-participating provider.
What is DF message 1134?
These 3 types of questions help understand the caller's needs.
What is Situation, Issue & Validation
In order to stay within HIPAA regulations; complete this step.
What is "Verification"?
The state that pays all providers (contracted & non-contracted)
What / Who is Illinois
"K": Can be used for provider write off
What is a Payment reduction reason code?
When the "Benefit" (home) plan suspects fraud on international claims they can let the Host plan know with the use of this DF message code.
What is DF message 1320?
Failing to complete the Total Customer Experience Section results in _____ points lost
What is / are 50 points?
4 attributes teaching empathy to callers.
What are Aware, Calm, Respectful,& Forgiving?
Reference for Effective & End dates of policy coverage
What is 800-676-2583?